Repetitive strain injury is a painful workplace condition, but help is at hand, writes Suzanne Harrison
FOR YEARS, repetitivestrain injury (RSI) was dismissed as an imaginary or exaggerated condition created by disgruntled office workers. Nowadays, although it may go by different names, there's no doubt it's a real problem - and so is the pain.
'We see it all the time,' says Jenny Woolsey, Sutherland Chan Centre director and a massage therapist. 'Maybe the term RSI has fallen out of favour. It includes things like carpal tunnel syndrome, or tennis elbow in those who've never played tennis.
'It's often a repetitive strain injury in people who type a lot, so I see mostly office workers,' Woolsey says.
Occupational overuse syndrome, work-related upper limb injury, and isometric contraction myopathy are all terms used to describe RSI.
Physiotherapist Justin Faulkner, from PhysioCentral, says the general term for RSI now is overuse injury - in part because insurance companies are sceptical about RSI diagnoses.
Faulkner says that there's no question that RSI-associated pains are real. Typically, a physiotherapist will correct the ergonomics of patients' work stations and make sure they're stretching correctly. 'Most of the time, the condition goes away with proper treatment,' he says.
Woolsey says a lot of her treatment also entails teaching people about ergonomics, such as occasionally switching the computer mouse to their other hand.
The type of massage used depends on the condition. Often it involves separating the muscle fibres of the tissue and the fascial fibres that become adhered together due to inflammation.
'If there's scar tissue, which you see after severe inflammation, we go in and break it up. It can be painful - but it's only for five minutes,' she says.
RSI is sometimes related to the thoracic outlet - the area between the collarbone and first rib where nerves and blood vessels enter the arm.
'If there's compression, the pectoral muscles and fascia are tight and people get numbness, tingling and weakness in their arms,' Woolsey says. 'They don't know that it's coming from the neck and chest. It's usually a combination of poor posture and sitting there typing.'
Other forms of RSI can be due to degeneration of the cervical spine in the neck. Small holes where arteries connect to the central nervous system become compressed, so therapists manipulate the joints. 'If it's not getting enough space, you get tingling and numbness,' Woolsey says.
Professional massage can relieve the pain associated with some RSI, but can it treat the problem?
Woolsey says it can - typically in conjunction with physiotherapy in severe cases, and by examining the cause of the problem. 'We do a lot of soft-tissue release through the neck and at the back in between the shoulder blades,' she says. 'We do treatment on the upper back as well.'
However, massage therapist Rose Chen (not her real name) doubts the value of massage or physiotherapy alone in treating RSI - although she strongly recommends them for relieving the pain.
The former legal secretary suffered for years from throbbing neck pain that ran down her right shoulder and along the top of her arm. She didn't go to a physiotherapist at the time. 'I didn't believe they could do anything,' Chen says. 'You have to stop doing the activity that's causing the problem - for example, using a keyboard or a mouse too often.'
Woolsey says that the number of massage treatments required depends on how bad the condition is. 'It takes a while to deal with. I have one client with tennis elbow who I'll see twice a week for at least two to three weeks and then once every three or four weeks,' she says. The client blames her computer mouse for the pain.
'How long it will take to clear it also depends on what she does at home. I'm getting her to do stretching and self-massage. I teach people to use gentle, small circles at the elbow and all the way through the top of the arm and then back again, follow this with stretches and then ice.'
Woolsey says people usually control the pain associated with the thoracic outlet in about a month, but tennis elbow can take six to eight weeks. 'Sometimes it doesn't completely go away, but is manageable.'
Anti-inflammatory drugs are typically prescribed by doctors. Woolsey says this can be helpful if the condition is severe. 'But its causes also need to be addressed.'
RSI is becoming more common in Hong Kong as office workers are tied to their desks in often cramped conditions. In 2004, the Hong Kong Polytechnic University's Rehabilitation Clinic reported a sharp rise in cases since it opened seven years earlier, from 71 patients in 1997 suffering from lower back, neck and shoulder pain to 402 by 2002.